Magic in Medicine

(upbeat music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals and students. I'm your host, Justin Kreuter, the bow tie bandit, a transfusion medicine pathologist at Mayo Clinic. It's April fools day and we have the perfect topic in store for you all. Today we're rounding with Dr. Reade Quinton, an assistant professor of laboratory medicine and pathology, and an anatomic pathologist at the department of laboratory medicine and pathology at Mayo Clinic.

Dr. Quinton is also happens to be a magician. So today we have the pleasure of talking with him about the magic in medicine. Thanks for joining us today, Dr. Quinton. - I'm happy to be back again. This is, I think my second or third time with you and these are always fun. - Yeah. Your second appearance on the podcast, we're jazzed to have you. And so what's your origin story?

How did you get started in magic? - You make it sound like it's the superhero origin story. - It kinda is, right? - Yeah. So actually it's a really neat story that relates to medicine in that most kids, if you look at most people that get magic, it's the classic like, I was about seven or eight years old and I had an uncle that would do card tricks and that gave me the bug and got me interested and that was not me actually.

I probably had my first deck of trick cards or something when I was about seven or eight but never really thought much of it. But it wasn't until I was in med school and I was on my cardiothoracic surgery rotation. And we had one of the retired surgeons would come in and do small topic talks with our small group of med students.

And after about 20 minutes of talking about pulmonary hypertension or whatever, he would then turn around and go, you guys wanna see a card trick and he'd start doing tricks for us. Now his name was Dr. Watts Webb. And last time I checked, he was still in New Orleans in his nineties and was still doing magic. It was amazing. But I realized at that time I got a big kick out of it but more importantly I knew my next rotation was going to be pediatrics.

And so I went to him and I said, you know this is really neat, how do you learn this? And that's what got me started. And so I went down that path a little bit, bought some books, bought some props. My wife I thought, oh, this is a great hobby because it's cheap. It's just a couple books and decks of cards and little did she know where that would go.

And eventually I would say my second big credit in guiding me would be Dr. Ricardo Rosenkrantz who's actually a neonatologist at Northwestern University. And he along with several professional magicians including Jeff McBride, Larry Haass and Eugene Burger, actually teach a medicine and magic class through the mystery magic school in Las Vegas. And so I met Ricardo and all of them through that and so that was the second part of this.

So I have to give a lot of the topics credit here in that a lot of the stuff I talk about really comes from what Ricardo started. - Wow. I think my thoracic surgery rotation experience in medical school, I remember it well, and I remember a lot more adrenal discharge than that, I imagine that was wonderful for learning, and then how does this roll into your practice

as an anatomic pathologist? How do you see this skill? How does this translate? - And so when I talk to students about this kind of thing, we talk about how does that translate because it was great in medical school, especially going on into that pediatric rotation, I could approach the patients in a different way and engage them before you just go in and start poking and prodding them. And so we joke now about, well, how in the world does that translate to pathology?

Particularly in my field of forensic pathology. And so there are many of the same concepts, but they don't necessarily translate to patient interaction. But essentially what I think of is in terms of, if you look at our practice, be it forensics or not, I look at the skillset as being scripting, costuming and audience engagement, if you will, those are my big three. So scripting in magic essentially is, there are people who perform magic just off the cuff and do it without any type of script.

But those aren't usually as successful as the stage magicians who have a very detailed script and know exactly what they're going to say every time. And so for me, I translate that into my engagement with, for instance, a jury, knowing when I sit on the stand, I know exactly what I'm going to say every time and then run through it multiple times. So there's that scripting and rehearsal so that when I get on the stand, I'm actually comfortable saying what I'm gonna say.

Costuming, at some point in our careers I think we've all had the experience where we run into the doc who wants to be a little more laid back and they're like, I don't want my patients to be intimidated by me so they basically wear the white coat, but there're sporting jeans and a polo shirt or something like that. I'm not saying that's a bad thing, but costuming is important because it engages the audience and tells them who is this person.

So there was Max Maven who's a mentalist and he really would be upset if you called him a magician but he's more of a mentalist. - And maybe for our listeners, can you just...

What is a mentalist? Because I think before I got to really spend some time with you, I was unclear about what that meant. - Sure. So mentalists are basically the guys who their entire show is based on like mind reading, predictions, things like that. So not really what you'd expect as far as like big stage illusions or things like that. And that's another thing, is that magic basically is like medicine in that there are multiple subspecialties.

So mentalism is a subspecialty within the larger field of magic. But anyway, Max Mavin, when he talks about audience engagement, he says, as soon as you step out on stage, the audience has their own internal dialogue. And they're thinking basically, who is this person? What do they do? And why should I care?

And he postulated that the faster you can address those questions, the more successful you are going to be because they'll be sort of calm down and go, okay, I understand what I'm getting into here. And so we think of that in medicine, in the same terms. So if I have the appropriate costuming and I look like a physician, then when I walk in to see a patient, that's one less box for them to tick, is who is this person?

Because if you walk in wearing different costuming, they might go, well, is this the nurse, is this the doctor, is this a student? So there's a lot of questions that they're trying to deal with. So that's another element of what we do. So especially in, again, in my field when I'm testifying, you walk in looking a certain way because that's what the jury expects you to look like. And so that's scripting and costuming. And then audience engagement in general.

Just learning how to engage your audience/jury/patient, to basically be able to answer those questions quickly, get to the root of what their concerns are, understand what is their internal dialogue that they're having so that you can address their questions and it's everything from eye contact to the simple things of public speaking we always talk about. Do you project your voice well? Do you mumble? Do you look down at your notes the whole time instead of engaging with the patient or the jury?

So I think all of those topics translate very well between the theatricality of magic and the theatricality of medicine. - Yeah. I think for our listeners, I love how you broke it down to these concepts, scripts, costume, and audience. I mean, with regarding script what I hear you saying is, you're talking about this preparation that's happening behind the scenes. And I equate that to how we think about attribute like some great artists is like, they're just brilliant.

And we don't see all the years of practice and failures about that. And I think for our residents and fellows, a lot it's times, it just seems like, wow, Dr. Quinton just always knows the right answer or he's just really on point. And we just hope that someday that we can be that quick with our answers, but I think it maybe lays ourselves bare to just highlight that there's a lot of preparation that goes into being a great physician.

- Yeah. And the funny thing is, you say you focused on that preparation aspect and the strange thing about magic is that, unlike every other form of art, oftentimes we're trying to hide our skillset. So if we make it look like something is spontaneous and natural that's success, but it doesn't look like we did anything. So a lot of that preparation and practice and the hours and hours of anxiety that go behind that, nobody ever perceives because the end goal is for them not to see it.

- Wow. And then costuming, I feel like I'm gonna come to you like with... This is a great way to explain how do we think about professionalism and things like that, that I think in medical education, sometimes it's more challenging for us to address deficits and professionalism in contrast to medical knowledge, for example. - Yeah, for sure. - So I really like how you broke that down. I think that's a lot for our audience to take with you. I'm curious now about these concepts,

how do you approach teaching our residents and fellows about how they might think about and use magic in their practice? I know you're not necessarily, maybe there's a couple that have been full converts and are card carrying members of the brotherhood, but I imagine too there's also some things that they can... So these are certainly concepts that they can take forward in their career.

- Sure. And so much of it is almost by osmosis and quite frankly oftentimes we're not spelling out that these are these practices from what I've learned in magic. But as we, you, me, all of us interact with students and residents and all that, it's those little touches where we engage with them and they're giving a presentation and we give them feedback afterwards and say, oh, I might have done this or even thinking about a PowerPoint presentation

and how are we critique? How much is on the slide? Don't read off the slide, all of that is the same skillset. And so even if they don't know they're learning some that skillset that it's behind the scenes that we're teaching it. In a more formal way, when I first got here to Mayo, I actually reached out to the... We have on campus, a center for humanities that engages and basically uses the arts to talk about medicine in a little bit of a way.

And when I reached out to them, they actually connected me with the medical student group. There's an actual humanities in medicine interest group for the medical students here. And so they do basically lunch lectures with different people who do all kinds of different things outside of medicine. And so for three years in a row I've actually gone back to give them magic and medicine talks and the med students really enjoy it.

So it's a fun formal way to say, that's my plan as opposed to with the residents, oftentimes it's on service and it's sort of secretive like, yeah, I'm feeding you this knowledge but you might know it's coming from this place. - I think our audience knows last time we were celebrating the fact that you had won teacher of the year award given to you from the resident class here in anatomic pathology and I imagine that being a good teacher right there, when you're dealing with your...

When you're teaching somebody, who's maybe more junior, a lot of concepts in medical practice are quite complex and you almost need a little bit of a suspension of a lot of the details for that beginner learner to take those first steps, feel successful, gain some confidence and get ready to understand some of the nitty gritty. I think about that a lot when I'm talking about these concepts in transfusion medicine with a resident versus a fellow. You're covering it in different ways.

I'm curious, do you see that in your practice and do you see yourself kind of... How do you... How can we....

I mean, there's a lot of medical educators that are listening to this podcast. How can we get better at suspending some of that belief for our residents and not get caught up in some of that nitty gritty? - Sure. The question is fantasic. And it comes down to that same concept of understanding what their internal dialogue is. So when we talk about speaking to a patient, we're trying to think about and anticipate, what are their questions behind the scenes? Why does this hurt? Am I going to die?

Sometimes it's really deep questions. For the residents obviously it might not be that level, but I think for us to put ourselves in their shoes, bring ourselves down a little bit, you don't necessarily want to... You need to express your own human humanity too. So be able to get down to their level and understand behind the scenes. Okay. When I was in that position, what did I understand? And start from that baseline and go from there.

So again, anticipating like, okay, as a first year resident, what kind of questions would they have if they don't know they have that question or maybe they're too afraid to ask that question and then try to anticipate and answer some of those as we go even if they haven't been presented to me. - I love how you're really, it sounds like, you that beginner's mindset and we need to remember that, think about that.

This last question is what that, in the spirit of being transparent this concept of script that you've introduced us to Dr. Quinton. This last question is a little bit of a doozy, but I gave this to you ahead of time to think about because it's such a doozy. So for our listeners this isn't Dr. Quinton off the cuff, but I asked him and what I'm gonna ask him right now is,

what would an ACGME milestone on magic in pathology look like? And so I'm curious for your thoughts and this isn't the typical final question but I think it's a neat way for us to get our arms around these conversations some of these concepts that you've shared with us and also make it a little bit more concrete for our listeners. - Sure. So I did struggle with this because honestly there's two ways to look at it.

So one way which I started with was basically, if I had to write milestones for magic, what would they be? And then I backtracked from there and said, okay, now how would I apply this to what we do in pathology? So just for fun, I actually do wanna share with you and I'm gonna move this on my screen so I can see it. But I did create the milestones for magic first. And I think you'll be amused by these but basically going for one to five, one being the lowest beginner all the way up to five.

And hopefully most of our learners know what the milestones are, but basically... So number one in magic, if you were just starting at your baseline milestone, I just have it listed as perform self-working card trick that they from their uncle. So just the very simple basics. And then the second one is, that I wrote in that same category is, aware that you should not expose secrets.

Now, I don't say, don't expose secrets because pretty much everybody at level one does, but they're aware you probably shouldn't. So this is going back to that idea of seven or eight year old who is learning their first trick. They're so excited about it. It's a self working card trick or something like that. But then of course they immediately show you how they did it even though they know something they probably shouldn't.

So level two in the milestone though, I have identified different types of magic. So now you're understanding, oh, there's card tricks, coin tricks, the kids shows, mentalism that kind of thing. Aware of resources available, including books, videos, and mentors can perform basics sleight of hand with one or two props. So you're only focusing on one or two things. Performs for family and friends and does not intentionally expose methods.

So now you've gotten to the point where you know I shouldn't give it away, I'm trying not to give it away, but sometimes maybe I don't have the dexterity to not give it away so some people will catch me. So then milestone number three would be comfortably performs magic in front of strangers. So not just family and friends in a close up setting. Familiar with sleights of several types of magic.

So this would be now you're familiar with coin magic, card magic, SpongeBob magic, whatever, but comfortable with one or two types. And then the third in there is, engages with other magicians in order to improve their practice. So that is you seeking out magicians or mentors to try to develop better habits or learn something. Then proficiency number four, comfortable performing in front of strangers including table and small stage settings may occasionally provide, put paid performances.

So now we're get into a whole new level. And then engages other magicians to both provide and receive constructive feedback. And then finally the level five would be comfortable in all types of performance venues, may engage in paid performances professionally or semi-professionally. And then the last part of that is mentors other magicians to improve their craft.

So that's where I went with magic which really made me wish I could just go ahead and write a whole book of milestones for magic because that was super fun. But moving on a little more specifically, so then I took that and tried to apply it back to pathology. And so I said, let me go through the framework of our own pathology milestones and see how I could rewrite them. And to be honest with you, Justin, I ended up going, I don't have to rewrite them.

So I went through and I found two core competencies that I think really are the most appropriate. There was in the big picture, patient care and the ICS, so interpersonal and communication skills. I thought those two core competencies really could apply to what we're talking about. And so as we go through these, these have nothing specifically to do with magic, but it goes back to the idea of the magic concepts or theater concepts. So for patient care, actually we have two that I selected out.

One is reporting and the other one is grossing. So in pathology obviously we develop reports and we gross specimens. And if you look at the grossing one, it's the same level one through five, basically level two is you're learning how to sample, you're learning how to document simple cases. By the time you get to level five, you can independently gross very complex specimens. So this translation is the same as I learned to do a self-working card trick versus I'm performing on stage.

With the reporting, it's the same as the scripting. Basically you're just learning how to identify key things that you would wanna talk about in your report. And then over the years, essentially learning how to generate a very complicated yet concise report, which the best scripting basically you start with a very big script and you keep whittling it down and you take out everything that is superfluous and get down to the simplest script.

And it's the same thing with our reports, is you don't want a bunch of extra stuff in there. And then for the interpersonal and communication skills, there's two of them I selected out which I think directly apply to what we're talking about. One was patient and family centered communication, and the other one was interprofessional and team communication.

So looking at the team one, just reading through it and going for instance, level three integrates feedback from team members to improve communication. So basically you're constantly talking to the team, learning from them and looping background and improving what you're doing by the time you get to level four, coordinates recommendations from different team members of the healthcare team to provide optimized patient care. So basically synthesizing all that.

So as we interact with patients or as we interact with team members, or at the same time as we interact with audience members, there's that constant feedback loop. So I say something, I get a response then I go, okay, I need to wrap that back into what I'm doing. And so I think in theater or in magic, the audience knows very quickly if you're not really engaged with them. So if you seem like you are just rattling off a script without actually engaging them, they will pick up on that.

And we see it in medicine too, where somebody's speaking and they're just so formal about their topic that they can't even adjust and answer questions because they're like, well, this is what I'm here to talk about, and that's it. So same thing with the patient and family centered communication, basically establishing relationships, like level four for that one. Independently recognizes personal biases while attempting to proactively minimize communication barriers.

If that's not theater, I don't know what is. So anyway, very long-winded answer to tell you that I think in our milestones there's already multiple things that apply to what we're talking about here. - That's the magic trick that you just did for our listeners. We didn't even know that magic was present in our milestones and you made it appear, you pulled it outta the hat, which is awesome. I feel like you've given me a new way to think about how can I talk about these issues with learners.

Cause you and I were talking before we got going recording here and I was sharing that I've been doing some simulation and thinking about wanting my learners to quote unquote, think like a pathologist. And that was a very nebulous thing when I started.

But as I was going forward, I've noticed through the feedback, what I really mean when I say that, is that they are truly listening to the patient, the team member and I see that reflected in what you were just saying about, being authentic, you know your script, you're prepared for it but you have to interact with that other person in an authentic way. If they ask a question, you have to really respond meaningfully to it. Not that no... That's not part of the script. We're doing the trick.

I see how this goes and I think this is really something beautiful for our Audience to think about and reflect. - In my own experience, having seen many magicians perform, I think a big eye opening thing for me was going to see, I'll highlight, there's a comedy magician named Mack king who's in Las Vegas. He's absolutely spectacular, been doing it a long time. And if you go see his show, it just seems so spontaneous. And he brings people up on stage and has just so much fun with them.

And you're like, wow, I cannot believe that he has this kind of rapport with these people. And then you go see his show again and you realize how incredibly scripted it is. But every time he brings someone up, there are those deviations because he does react differently for different things, what they say, what they do, but he's actively paying attention and reacting to what they say and do but then goes right back to script and in a way that they can never even perceive it.

It just seems... It flows is so naturally. So yeah I am still trying to develop that type of communication skill I think. - I hear in your answer there, I hear this is repetition is important. And I think for us as faculty observing that repetition so that we can help our learners get feedback that's relevant, that's gonna help them fine tune.

We've been rounding with Dr. Quinton, thank you for taking the time to discuss this topic with us. - Happy to be here. Thank you so much for having me. - If you'd like to hear more from Dr. Quinton, be sure to register for the seventh annual forensic science symposium. Dr. Quinton will be presenting on a variety of topics at this year's symposium to be held April 29th, 2022. For more information, visit mayocliniclabs.com/22 forensic. To all of our listeners, thank you for joining us today.

We invite you to share your thoughts and suggestions via email. Please direct any suggestions to mcleducation@mayo.edu and reference this podcast. If you've enjoyed lab medicine rounds podcast, please subscribe. Until our next rounds together. We encourage you to continue to connect that medicine in the clinical practice through insightful conversations. (upbeat music)